Pain Control Concepts

Patient Controlled Analgesia

Patients can have some control about giving themselves narcotics. They are hooked up to a pump, press a button and the pump administers narcotic. An addict may love this but of course the pump has a lock out on it because depending on how it’s programmed, you may only get one push every 3-4 hours.

There’s another button they could press, called the nurse call button. How long will it be before you get that narcotic in that case? It could be an hour. Someone has to find out why you pushed that button. After you say I’m in pain, the nurse needs to go to the nursing unit to acquire the narcotic, but in most nursing facilities, there is a witness required to acquire the narcotic, so they have to find another nurse who may be busy at that moment. Once two free nurses are together, they can check out the narcotic, check out the remaining inventory, draw up the narcotic and two of them have to go together to administer the dose together. This is because unfortunately there is a history of nurses stealing narcotics for themselves.

In which scenario does a patient require more narcotics? When they have to call for a nurse or push a button that automatically administers it? When they have to call for a nurse. The reason being is that when you’re in control of the medication, you will push the pump button when you feel the pain. When you’re not in control, you may push the call button well before the pain comes back so that you will ensure the pain won’t return. So patient controlled analgesia leads to less use of the drug in general.

Chronic terminal pain

We want to do anything possible to keep terminal patients as comfortable as possible. So we give them a long acting narcotic they have to take once or twice a day and never have to ask for pain medication. After a period of time the meds are not going to work as well and in their medication profile they’re going to have a short acting narcotic in addition to the long acting narcotic. We could deduce that the long-acting one isn’t working so well and increase the dose of it. Is the person addicted? Yes. Are we concerned about that? Absolutely not because it’s their comfort we are concerned about.

Post-operative use

Research has shown that if we could control the persons pain post-operatively for the first few days, they can recover faster and go back to work faster. Unfortunately narcotics are not adequately used to promote healing because of a social stigma where people don’t want to be put on narcotics. In reality, what’s the chance of a person being addicted to a narcotic in 3 days? Damn near zero.

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